St. Francis-Mountain View's Blake Billinger blew out his elbow last year.
Photo: Liz Hafalia, The Chronicle

St. Francis-Mountain View's Blake Billinger blew out his elbow last...

St. Francis-Mountain View senior baseball player Blake Billinger blew out his elbow at a college showcase last year, but his story may yet have a happy ending.
Photo: Liz Hafalia, The Chronicle

St. Francis-Mountain View senior baseball player Blake Billinger...

Kelly Furay, a senior at Campolindo-Moraga, says many former volleyball teammates "have shoulder injuries from continuously hitting and serving."
Photo: James Tensuan, SFC

Kelly Furay, a senior at Campolindo-Moraga, says many former...

Kelly Furay is aided in stretches by Robin Bousquet at the Sports Medicine Center for Young Athletes.
Photo: James Tensuan, SFC

Kelly Furay is aided in stretches by Robin Bousquet at the Sports...

Former volleyball player Kelly Furay works on stretches with senior physical therapist Robin Bousquet at the Sports Medicine Center for Young Athletes. "The amount of injuries is definitely increasing," Bousquet says.
Photo: James Tensuan, SFC

Former volleyball player Kelly Furay works on stretches with senior...

17-year-old Kelly Furay of Campolinda High School stretches before her appointment with Robin Bousquet At Sports Medicine for Young Athletes in Walnut Creek. Bousquet is a senior physical therapist who specializes in youth athletes.
Photo: James Tensuan, SFC

17-year-old Kelly Furay of Campolinda High School stretches before...

St. Francis high school senior Blake Billinger walks at his school baseball field in Mountain View, California as he talks about baseball.
Photo: Liz Hafalia, The Chronicle

St. Francis high school senior Blake Billinger walks at his school...

St. Francis high school senior Blake Billinger talks with the equipment room manager about his elbow surgery at school in Mountain View.
Photo: Liz Hafalia, The Chronicle

St. Francis high school senior Blake Billinger talks with the...

Senior sports medicine physical therapist Robin Bousquet at the current Sports Medicine Center which is located about a block away from the soon to open Sports Medicine Center for Young Adults in Walnut Creek, Calif. Children's Hospital in Oakland is ready to open a youth sports therapy center in Walnut Creek, aimed at preventing and treating youth sports injuries.
Photo: Michael Macor, The Chronicle

Senior sports medicine physical therapist Robin Bousquet at the...

Senior sports medical physical therapist Robin Bousquet in front of the building which will house the soon to open Sports Medicine Center for Young Adults in Walnut Creek. Children's Hospital in Oakland is ready to open a youth sports therapy center in Walnut Creek, aimed at preventing and treating youth sports injuries.
Photo: Michael Macor, The Chronicle

The current Sports Medicine Center which is located about a block away from the soon to open Sports Medicine Center for Young Adults in Walnut Creek, Calif. Children's Hospital in Oakland is ready to open a youth sports therapy center in Walnut Creek, aimed at preventing and treating youth sports injuries.
Photo: Michael Macor, The Chronicle

The current Sports Medicine Center which is located about a block...

Kelly Furay, 17, stretches before her appointment with Robin Bousquet at Sports Medicine for Young Athletes in Walnut Creek.
Photo: James Tensuan, SFC

Kelly Furay, 17, stretches before her appointment with Robin...

Robin Bousquet gives advice to Kelly Furay during an appointment at Sports Medicine for Young Athletes in Walnut Creek. Bousquet is a senior physical therapist who specializes in youth athletes.
Photo: James Tensuan, SFC

Senior sports medicine physical therapist Robin Bousquet at the still under construction but set to open soon, Sports Medicine Center for Young Adults in Walnut Creek.
Photo: Michael Macor, The Chronicle

Blake Billinger began playing baseball year-round at age 10, when he joined a club team and competed in tournaments nearly every weekend. Two years later, his Silicon Valley Yankees climbed in the national rankings and started traveling outside the Bay Area, from Los Angeles and Las Vegas to Florida and Kansas City.

Billinger pitched five to seven innings most weekends, but he always figured he rested enough. Even in the summer after his freshman year at St. Francis High in Mountain View, when tendinitis in his right shoulder sidelined him, Billinger was not especially worried.

Then his elbow made him worry - in a big way.

On Oct. 20, 2012, at a showcase event for college prospects in Arizona, he threw a pitch and instantly felt "a huge pop." His right elbow screamed in pain. Billinger dejectedly walked off the field, fearing for his baseball future.

"It was pretty nasty," he said. "I felt the burning and the stinging. I was scared. Are my pitching days done? It was breathtaking, to be honest."

Barely a month later, at age 16, he had reconstructive surgery on his ulnar collateral ligament, better known in baseball circles as Tommy John surgery. The procedure has long been common for major-league pitchers with years of wear and tear on their arms, but Billinger's case offers a stark reminder: Teenagers are vulnerable, too.

It's just one of the many side effects of specialization in youth sports. As more and more kids play the same sport year-round from an early age, they are increasingly vulnerable to injury.

This trend toward focusing on one sport can sharpen skills and even set young athletes on the path to scholarships and college success. But it also means more repetition, more strain and more injuries. Like many of the issues surrounding specialization, experts and athletes alike question whether the trend is in the kids' best interests.

When it comes to injuries, the numbers are stark. There has been a five-fold increase since 2000 in the number of serious elbow and shoulder injuries among youth baseball and softball players, according to the American Orthopaedic Society for Sports Medicine. The organization helped launch StopSportsInjuries.org, a website devoted to educating parents and young athletes about sports injuries.

Among the sobering statistics: Overuse injuries are responsible for nearly half of all sports injuries to middle school and high school students. Specialization is a logical culprit. A report this year by the sports medicine department at Loyola University of Chicago found that "kids are twice as likely to get hurt if they play just one sport as those who play multiple sports."

In 2003, when Bousquet started in the orthopedic department at Children's, the clinic where she worked was the size of four trailers. Now the hospital has two huge clinics, including a 6,000-square foot facility scheduled to open next week in Walnut Creek - exclusively dedicated to treating young athletes.

"There's more of a need, because the amount of injuries is definitely increasing," Bousquet said. "I see a lot of stress in athletes about practice time and playing time. I see a lot of stress about the pressure to perform. This has all increased 1,000 percent in the last six or seven years."

Dr. Kirk Jensen, an orthopedist in Oakland and Lafayette, recalled the time one father brought in his son, then 12 or 13. The kid was right-handed, but the dad had made him pitch left-handed, knowing lefties are considered more valuable.

He couldn't lift his arm because of shoulder pain, and his velocity had been dropping, according to the all-important radar gun at home. But the dad wanted Jensen to clear the kid to pitch in an upcoming all-star game.

Jensen, naturally, told him he needed rest.

Dad, naturally, got mad.

"There are a few nutsos," Jensen said. "But the days of baseball in the spring and summer only, and (then) not throwing for four months, are gone."

Jensen is a shoulder specialist, so he sees plenty of young baseball players who throw too much. He also runs an East Bay youth water polo program, so he sees swimmers and water polo players with shoulder injuries, too - plus many young soccer players with knee injuries.

His water polo club encourages kids to play other sports. Not long ago, during a 12-and-under practice, one water polo player approached Jensen to tell him he had to leave early for a basketball game.

Rather than scold the kid or demand his undivided sporting energy, Jensen said, "Have a good game."

This stems from his experience with young athletes who not only sustain injuries but also endure what Jensen called emotional burnout. Such kids dedicate themselves to one sport starting at age 9 or 10, reach their junior or senior year of high school - and then don't want to play anymore.

"Personally, up until age 14 or 15, I think kids should play as many sports as they can," Jensen said. "Then, when they get to high school, they can decide which one they want to play."

It's a tricky balancing act, given the increasingly fierce competition to make high school teams and the potential pursuit of college scholarships. Dr. Marc Safran, associate chief of sports medicine at Stanford Medical Center, knows the benefits of playing multiple sports but also understands the need to eventually specialize.

Safran encouraged his daughter, a swimmer, not to specialize until age 12. One of his now teenage sons started to focus exclusively on tennis at age 11, and the other, also a tennis player, set aside other sports at 13.

There's no foolproof formula, though Safran warned of the danger of playing some sports, such as golf, tennis or baseball, year-round at young ages. Those are what he called "unilateral arm-dominant sports," making proper technique and proper rest all the more essential.

"You're always using the arms or body in the same way, and you're not getting that cross-training experience," Safran said. "That is ultimately an issue."

Or, as Bousquet said, "No one was born to throw a baseball overhand 100 times; doing that is not an inherent thing for humans. And now we're going to make 10- or 11-year-olds do it year-round?"

Some kids start even younger. Nick Fafoutis, a sophomore at Campolindo High in Moraga, began playing travel baseball at age 7 on a 9-and-under team. He stayed involved in football and basketball to some extent in the ensuing years, but baseball was his sport. He played 10 months a year, January through October, as a catcher and infielder.

Fafoutis recently completed a one-year prohibition on throwing because of shoulder problems. He spent last season as the designated hitter on Campolindo's junior varsity. His dad, Mike, isn't convinced the injury resulted from overuse, but he also said, "My guess is, it's probably from playing baseball. ... If you throw a ball every day for nine months, there are going to be issues."

That doesn't stop many kids from plowing ahead, mostly because they don't know any better. Mike Fafoutis wishes he had known more about preventive arm exercises for his son, a regret echoed by Billinger, the St. Francis pitcher coming back from elbow surgery.

Billinger insisted his coaches were careful with him, but many coaches don't keep pitch counts and place more emphasis on winning. Clint Hoover, a longtime club coach at Lamorinda Baseball Academy, asks his scorekeepers to tabulate pitches for both teams, and he's seen 12-year-old opponents throw 130 in a single weekend.

No wonder many young pitchers reach high school with serious issues.

"It just seems like everybody's arm is messed up now, to some degree," St. Francis coach Mike Oakland said. "It's the kids who grow up as pitchers, just because of the absurd abuse they take in travel ball. They don't ever take a break, and their throwing programs aren't monitored the way they should be."

Billinger, now 17 and a high school senior, also played basketball and flag football in middle school, but baseball was a "full-time commitment." He attracted the attention of recruiters from major-college programs across the nation - at least until that day in Arizona when his elbow popped.

Just as suddenly, the recruiting stopped.

Billinger, who lives in Los Gatos, said his doctor wasn't entirely sure what caused the torn UCL but suspected it was linked to the earlier bout with shoulder tendinitis. That likely put more stress on Billinger's elbow.

He still doesn't regret the long seasons and frequent travel when he was younger, mostly because he had fun. Still, Billinger acknowledged he wasn't educated enough about arm maintenance; he wishes he had done more preventive exercises and thrown three to five innings per weekend, instead of five to seven.

"I was totally naive to arm problems when I was younger," Billinger said. "I thought I was invincible."

That's exactly the kind of youthful bravado that Dr. James Andrews, the noted orthopedist, has tried to counter. One of Andrews' specific guidelines: Young pitchers shouldn't begin throwing a curveball until they begin shaving (Billinger, it should be noted, didn't throw a curveball until age 14). Among Andrews' other baseball recommendations are focusing on proper pitching mechanics, taking three to four months off each year, and avoiding the use of a radar gun at a young age because it leads to overthrowing.

Other sports also are prone to overuse injuries. Stopsportsinjuries.org includes guidelines for sports ranging from cycling and lacrosse to swimming and volleyball.

Kelly Furay, a senior at Campolindo-Moraga, started playing volleyball in fourth grade and joined a club program in sixth grade. She quit last year because of constant back pain, a problem her doctor linked to scoliosis, a hereditary curvature of the spine. But Furay also was a firsthand witness to several teammates who endured lingering overuse injuries.

"It's just the repetition," she said. "I know so many people who have shoulder injuries from continuously hitting and serving."

Bousquet, the physical therapist, finds particular frustration in the abundance of torn anterior cruciate ligaments in youth soccer. Those knee injuries might not trace directly to overuse, but Bousquet contends kids need more strength in their hips and core to support frequent pivoting.

"In soccer, kids need to work on more of the conditioning," she said. "It's not playing soccer 100 percent of the time."

The new Sports Medicine Center in Walnut Creek, where Bousquet works, will be the first sports medicine program in Northern California geared exclusively for young athletes. Programs will include injury prevention techniques, nutrition and diagnostic imaging that will help tailor training routines to specific body types.

Billinger could have used such tools when he was younger. But his Tommy John surgery introduced him to a new reality, one in which he diligently follows his prescribed exercise routine. He's slowly been resuming throwing and focusing more on his hitting.

His story might have a happy ending: Billinger accepted a scholarship offer this past summer to play college baseball at Florida International. It doesn't hurt that he stands 6-foot-4, weighs 225 pounds and wields a mighty bat.

Still, he now knows he's not invincible.

Editor's note

Youth sports have changed dramatically over the years, with more athletes specializing in one sport from an early age. In a three-part series, The Chronicle explores the impact of specialization on youth sports.